Provider Demographics
NPI:1427041078
Name:WIENER, ISAAC (MD)
Entity Type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:WIENER
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16542 VENTURA BLVD STE 402
Mailing Address - Street 2:
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91436-4562
Mailing Address - Country:US
Mailing Address - Phone:818-782-5041
Mailing Address - Fax:818-205-9091
Practice Address - Street 1:10921 WILSHIRE BLVD STE 1205
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90024-4005
Practice Address - Country:US
Practice Address - Phone:310-824-3378
Practice Address - Fax:310-208-2870
Is Sole Proprietor?:No
Enumeration Date:2005-08-30
Last Update Date:2022-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG46722207RC0000X, 207RC0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0001XAllopathic & Osteopathic PhysiciansInternal MedicineClinical Cardiac Electrophysiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G467220Medicaid
CAWG46722DMedicare PIN
CAA50476Medicare UPIN
CAWG46722JMedicare PIN
CACT979ZMedicare PIN
CAWG46822KMedicare PIN
CAWG46722EMedicare PIN
CA00G467220Medicaid
CAWG46722IMedicare PIN